Department of Anesthesiology and Pain Relief Center, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
Department of Anesthesiology, Tokyo Teishin Hospital, 2-14-23 Fujimi, Chiyoda-ku, Tokyo, 102-8798, Japan.
J Clin Monit Comput. 2020 Apr;34(2):371-377. doi: 10.1007/s10877-019-00305-z. Epub 2019 Apr 1.
Clinical anesthesiologists, particularly residents, work in stressful environments. However, evidence-based physiological and psychological tests to evaluate stress are still lacking. In this single-center study of 33 residents, we investigated the relationship between heart rate variability (HRV), which had the potential to screen residents' stress levels using Holter electrocardiography (ECG) and psychological mood as assessed by the Profile of Mood States (POMS) questionnaire. HRV analysis revealed 2 findings. Firstly, standard deviation of the average of 5-min normal-to-normal R-R intervals (SDANN) was significant lower than that of same-aged healthy volunteers (69.3 ± 27.9 vs. 137.0 ± 43.0 ms, P < 0.05), which indicated suppression of autonomic nervous system activity throughout their work. Secondly, at induction of anesthesia, significant higher low frequency/high frequency ratio (LF/HF ratio: 1.326 vs. 0.846; P < 0.05) and lower HF (3326 vs. 5967 ms; P < 0.05) and lower standard deviation of normal-to-normal R-R intervals (SDNN: 50.5 vs. 79.4 ms; nervous system was suppressed at the induction of anesthesia: expected to be the most stressful period of their work. On the other hand, deviation scores of POMS questionnaire elucidated that all the residents were within normal range of psychological mood, and without any significant diurnal changes with respect to total mood disturbance deviation (TMD) scores (48 vs. 47; P = 0.368). HRV elucidated physiological stress among anesthesiology residents quantitatively by evaluating autonomic nervous activities, especially at induction of anesthesia. These changes in HRV could be observed regardless of psychological mood.
临床麻醉医师，尤其是住院医师，工作在充满压力的环境中。然而，目前仍然缺乏基于证据的生理和心理测试来评估压力。在这项对 33 名住院医师的单中心研究中，我们通过动态心电图（Holter ECG）评估心率变异性（HRV），并结合 POMS 问卷评估心理情绪，研究了两者之间的关系。HRV 分析显示了 2 个发现。首先，平均 5 分钟正常窦性 R-R 间期标准差（SDANN）显著低于同年龄健康志愿者（69.3 ± 27.9 vs. 137.0 ± 43.0 ms，P < 0.05），表明自主神经系统活动受到抑制。其次，在麻醉诱导时，低频/高频比值（LF/HF 比值：1.326 vs. 0.846；P < 0.05）显著升高，高频（HF）显著降低（3326 vs. 5967 ms；P < 0.05），正常窦性 R-R 间期标准差（SDNN）显著降低（50.5 vs. 79.4 ms；P < 0.05），提示麻醉诱导时自主神经系统受到抑制：这可能是他们工作中最具压力的时期。另一方面，POMS 问卷的偏差评分表明，所有住院医师的心理情绪均处于正常范围内，总情绪干扰偏差（TMD）评分无明显昼夜变化（48 vs. 47；P = 0.368）。HRV 通过评估自主神经活动，对麻醉科住院医师的生理压力进行了定量评估，尤其是在麻醉诱导时。这些 HRV 的变化可以观察到，而与心理情绪无关。
